Calendar-period trends in cervical precancer and cancer diagnoses since the introduction of human papillomavirus and cytology co-testing into routine cervical cancer screening at Kaiser Permanente Northern California

Brian Befano; Nicolas Wentzensen; Thomas Lorey; Nancy Poitras; Li C Cheung; Mark Schiffman; Megan A Clarke; Camryn Cohen; Walter Kinney; Alex Locke; Philip E Castle

doi:10.1016/j.ygyno.2024.01.038

Calendar-period trends in cervical precancer and cancer diagnoses since the introduction of human papillomavirus and cytology co-testing into routine cervical cancer screening at Kaiser Permanente Northern California

Gynecol Oncol. 2024 Jan 31:184:89-95. doi: 10.1016/j.ygyno.2024.01.038. Online ahead of print.

Authors

Affiliations

¹ Information Management Services, Calverton, MD, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.
² Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA.
³ Kaiser Permanante, The Permanante Medical Group Regional Laboratory, Berkeley, CA, USA.
⁴ Sacramento, CA, USA.
⁵ Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA; Division of Cancer Prevention, U.S. National Cancer Institute, Rockville, MD, USA. Electronic address: philip.castle@nih.gov.

PMID: 38301311
DOI: 10.1016/j.ygyno.2024.01.038

Abstract

Objectives: The longer-term impact of introducing human papillomavirus (HPV) testing into routine cervical cancer screening on precancer and cancer rates by histologic type has not been well described. Calendar trends in diagnoses were examined using data from Kaiser Permanente Northern California, which introduced triennial HPV and cytology co-testing in 2003 for women aged ≥30 years.

Methods: We examined trends in cervical precancer (cervical intraepithelial neoplasia grade 3 [CIN3] and adenocarcinoma in situ [AIS]) and cancer (squamous cell carcinoma [SCC] and adenocarcinoma [ADC]) diagnoses per 1000 screened during 2003-2018. We examined ratios of squamous vs. glandular diagnoses (SCC:ADC and CIN3:AIS).

Results: CIN3 and AIS diagnoses increased approximately 2% and 3% annually, respectively (p_trend < 0.001 for both). While SCC diagnoses decreased by 5% per annually (p_trend < 0.001), ADC diagnoses did not change. These patterns were generally observed within each age group (30-39, 40-49, and 50-64 years). ADC diagnoses per 1000 screened did not change even among those who underwent co-testing starting in 2003-2006. SCC:ADC decreased from approximately 2.5:1 in 2003-2006 to 1.3:1 in 2015-2018 while the CIN3:AIS remained relatively constant, ∼10:1.

Conclusions: Since its introduction at KPNC, co-testing increased the detection of CIN3 over time, which likely caused a subsequent reduction of SCC. However, there has been no observed decrease in ADC. One possible explanation for lack of effectiveness against ADC is the underdiagnosis of AIS. Novel strategies to identify and treat women at high risk of ADC need to be developed and clinically validated.

Keywords: Adenocarcinoma (ADC); Adenocarcinoma in situ (AIS); Cervical cancer; Cervical intraepithelial neoplasia grade 3 (CIN3); Cervical precancer; Co-testing; Cytology; Human papillomavirus (HPV); Pap; Squamous cell carcinoma (SCC).

Published by Elsevier Inc.